WAKE SPECIALTY PHYSICIANS LLC (NPI# 1417340290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417340290 |
| Entity Type | Organization |
| Organization Name | WAKE SPECIALTY PHYSICIANS LLC |
| Other Organization Name | WAKEMED ENT HEAD & NECK SURGERY |
| Practice Address |
3024 New Bern Ave Raleigh NC 27610-1247 |
| Mailing Address |
Po Box 602195 Charlotte NC 28260-2195 |
| Practice Telephone | 9193507856 |
| Practice Fax Number | 9193507687 |
| Mailing Telephone | 9193500552 |
| Mailing Fax Number | 9193507687 |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2015-12-31 |
| Authorized Official Name | MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE) |
| Authorized Official Telephone | 9193506089 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 1942440375 | 05 | |
| NC | DME PTAN | 7108950003 | 01 |
| Other Name | Type Code |
|---|---|
| WakeMed ENT Head & Neck Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225684004 | Wake Specialty Physicians LLC | Internal Medicine | 11640 Northpark Dr, Wake Forest, NC 27587-5741 | 2019-08-16 |
| 1841713187 | Wake Specialty Physicians LLC | Internal Medicine | 3000 New Bern Ave Ste 1200, Raleigh, NC 27610-1231 | 2017-07-19 |
| 1740702497 | Wake Specialty Physicians LLC | Internal Medicine | 101 Cotten Ln, Holly Springs, NC 27540-8415 | 2017-07-14 |
| 1407267347 | Wake Specialty Physicians LLC | Family Medicine | 3020 New Bern Ave, Raleigh, NC 27610-1215 | 2014-05-14 |
| 1225449168 | Wake Specialty Physicians LLC | Internal Medicine | 901 Old Knight Rd, Knightdale, NC 27545-9065 | 2014-05-14 |
| 1699186619 | Wake Specialty Physicians LLC | Family Medicine | 150 E Davie St, Raleigh, NC 27601-1806 | 2014-05-13 |
| 1346501673 | Wake Specialty Physicians LLC | Internal Medicine | 400 Us Highway 70 East, Garner, NC 27529-4049 | 2012-06-04 |
| 1427604149 | Wake Specialty Physicians LLC | Family Medicine | 7560 Carpenter Fire Station Rd, Cary, NC 27519-9637 | 2019-08-19 |
| 1871052597 | Wake Specialty Physicians LLC | Internal Medicine | 222 Ashville Ave, Cary, NC 27518-6130 | 2019-03-13 |
| 1649741950 | Wake Specialty Physicians LLC | Otolaryngology | 10010 Falls of Neuse Rd, Raleigh, NC 27614-8494 | 2018-12-13 |
| Street Address |
3024 NEW BERN AVE |
| City | RALEIGH |
| State | NC |
| Zip Code | 27610-1247 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588664924 | Lynn M Rebello | Pediatrics | 3024 New Bern Ave, Raleigh, NC 27610 | 2005-07-28 |
| 1275158206 | Alejandro Ramirez Lopez | Physician Assistant | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2020-06-16 |
| 1588225759 | Wakemed Specialists Group, LLC | Preventive Medicine | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-06-27 |
| 1821659079 | Sharon Elizabeth Booth | Physician Assistant | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-06-27 |
| 1790343366 | Wakemed Specialists Group LLC | Pediatrics | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-30 |
| 1225693419 | Wakemed Specialists Group LLC | Surgery | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| 1720643927 | Wakemed Specialists Group, LLC | Otolaryngology | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| 1649835836 | Wakemed Specialists Group, LLC | Internal Medicine | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| 1205491487 | Wakemed Specialists Group LLC | Urology | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| 1639734817 | Wakemed Specialists Group, LLC | Nutritionist | 3024 New Bern Ave, Raleigh, NC 27610-1247 | 2019-05-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609499243 | Elizabeth Ranganai Mavindidze | Social Worker | Wakemed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610 | 2020-05-18 |
| 1851958839 | Alex & Associates, P.C. | Dentist | 1600 Cross Link Road, Unit 103, Raleigh, NC 27610 | 2019-05-24 |
| 1639646367 | Carol Mary Medins | Dietitian, Registered | Wakemed Raleigh Medical Park, 23 Sunnybrook Road, Suite 200, Raleigh, NC 27610 | 2018-10-31 |
| 1144714601 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 123 Sunnybrook Rd Ste 150, Raleigh, NC 27610 | 2018-06-19 |
| 1417446006 | Eagles Eye Lab, Inc | Clinical Medical Laboratory | 4501 New Bern Ave, Ste: 130, Raleigh, NC 27610 | 2018-05-09 |
| 1316465206 | Jeffery King Neer | Social Worker | 3010 Falstaff Rd., C/o Unc Actt, Raleigh, NC 27610 | 2017-08-31 |
| 1083139885 | Kelsey Daniel Mccleave | Social Worker | 3630 Enduring Freedom Drive, Raleigh, NC 27610 | 2017-08-14 |
| 1891219093 | Tarheel Residential Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4840 Quarryman Road, Raleigh, NC 27610 | 2017-07-29 |
| 1508214826 | Compassionate Care Providers LLC | Respite Care | 5110 Wetlands, Raleigh, NC 27610 | 2016-05-26 |
| 1730552530 | Matthew Belair | Pharmacist | 1601-51 Cross Link Rd, Raleigh, NC 27610 | 2015-11-03 |
| Find all providers in zip 27610 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306445648 | Good Hope Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 3601 Capital Blvd Ste 101, Raleigh, NC 27604-3397 | 2020-10-19 |
| 1518573468 | Joemax Healthcare Services LLC | Durable Medical Equipment & Medical Supplies | 3535 S Wilmington St Ste 208, Raleigh, NC 27603-3512 | 2020-09-16 |
| 1265059398 | Tiara Hyman | Durable Medical Equipment & Medical Supplies | 10040 Pineville Rd, Raleigh, NC 27617-6310 | 2020-07-06 |
| 1265055099 | Best American Medical Supplies LLC | Durable Medical Equipment & Medical Supplies | 1100 Navaho Dr Ste 121, Raleigh, NC 27609-7364 | 2020-05-27 |
| 1619516978 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 417 W Peace St Ste 100, Raleigh, NC 27603-5017 | 2020-01-03 |
| 1205471521 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 500 Oberlin Rd, Raleigh, NC 27605-1318 | 2019-11-11 |
| 1326681164 | Wakemed Specialists Group, LLC | Durable Medical Equipment & Medical Supplies | 2930 Forestville Rd Ste 100, Raleigh, NC 27616-8774 | 2019-10-24 |
| 1558820266 | Active Healthcare, Inc. | Durable Medical Equipment & Medical Supplies | 9104 Falls of Neuse Rd Ste 100, Raleigh, NC 27615-2494 | 2019-03-13 |
| 1912465311 | Shivag Diabetic Shoes and Orthotics LLC | Durable Medical Equipment & Medical Supplies | 3113 Brentwood Rd, Raleigh, NC 27604-2425 | 2019-03-05 |
| 1992273312 | Theramed Equipment and Supplies LLC | Durable Medical Equipment & Medical Supplies | 5720 Capital Blvd Ste G, Raleigh, NC 27616-2953 | 2018-11-03 |
| Find all providers in RALEIGH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.